Digital Commons Network^™

Persistent Symptoms In Endoscopic Remission: Social Determinants & Non-Medical Interventions In Inflammatory Bowel Diseases, Hang Phuong Nguyen

Yale Medicine Thesis Digital Library

Inflammatory Bowel Diseases (IBD) are chronic gastrointestinal disorders, namely Crohn's disease (CD) and ulcerative colitis (UC), affecting ~1.6 million people in the U.S. Gastrointestinal (GI) symptoms such as abdominal pain, diarrhea, and rectal bleeding may persist even when endoscopic and histologic findings appear normal (i.e., endoscopic-histologic remission). However, the prevalence of GI symptoms despite endoscopic-histologic mucosal healing remains unclear. Additionally, there is limited research on the impact of non-clinical factors, such as social determinants of health (SDOH), on persistent GI symptoms in patients with endoscopic remission. SDOH refers to conditions in environments—including, but not limited to, housing, transportation, neighborhoods, income, …

Website Accessibility Of Largest Health Insurers In Medicare Advantage Market, Alicia Stephan

Yale Medicine Thesis Digital Library

Website accessibility is essential to ensure equitable healthcare access, especially for individuals with disabilities. This study evaluated the accessibility of health insurance websites for the ten largest Medicare Advantage insurers by market share. Using three free, publicly available automated accessibility checkers—WAVE, Axe-Core, and Skilltide—we systematically identified five URLs per insurer based on specific webpage keywords. These tools adhere to the Web Content Accessibility Guidelines (WCAG) Version 2.1 Level AA, the technical standard referenced in the most recent U.S. legislation.A total of 1,223 accessibility errors were identified across 50 webpages, with Skilltide detecting the most errors (588), followed by WAVE (502) …

Evaluating Nebulizer Efficiency For Phage Therapy In Drug-Resistant Pseudomonas Infections, Daniel Thompson

Yale Medicine Thesis Digital Library

Background

The global rise of multidrug-resistant (MDR) Pseudomonas aeruginosa necessitates novel therapeutic approaches, particularly for patients with cystic fibrosis (CF). Bacteriophage therapy, delivered via inhalation, offers a targeted and potentially transformative treatment for pulmonary infections caused by MDR pathogens. This study aimed to evaluate the effects of nebulizer type and bacteriophage morphology on viable phage recovery and aerosol particle size distribution, hypothesizing that nebulizer-phage compatibility significantly influences the delivery of viable phages to the lower respiratory tract.

Methods

We conducted an in vitro study utilizing two clinically relevant nebulizer systems: the Pari LC Plus jet nebulizer and the Altera eFlow …

Personalized Therapeutic Approaches For Cutaneous T-Cell Lymphoma (Ctcl), Madisen Swallow

Yale Medicine Thesis Digital Library

Cutaneous T-cell lymphoma (CTCL) is a non-Hodgkin lymphoma characterized as a malignancy of T-cells that variably involves the skin, lymph nodes, and blood. Many therapeutic options exist for patients with CTCL, ranging from narrow-band UVB, extracorporeal photopheresis, total skin electron beam therapy, retinoids, histone deacetylase inhibitors, antibody drug conjugates, and chimeric antigen receptor (CAR) T-cell therapy. Despite the various advances in treatment options, these therapies are non-curative with overall response rates ranging from 30 to 55%, warranting the need for better alternatives that also aim to reduce toxic systemic effects. Project 1: Prior work in a series of publications by …

Analysis Of Post-Operative Recovery From Microsurgical Breast Reconstruction As Modified By Anterior Quadratus Lumborum Regional Blockade, Cory Wu

Yale Medicine Thesis Digital Library

Breast cancer patients who undergo mastectomy for treatment have the option to proceed with cosmetic breast reconstruction, of which microsurgical flap techniques have become more and more predominant. Optimized recovery from these large-scale surgeries can impact both hospital resources and long-term patient health. The abdominal donor site is the prime suspect for the postoperative pain and delay in return of baseline functional status. Previous literature and clinical practice support the surgically placed transverses abdominal regional block as part of the multimodal analgesia regimen to aid recovery due to incisional pain control, but the technique lacks the ability to impact visceral …

Litigating Landlessness: The U.S. Department Of The Interior And First Circuit Court’S Appropriations Of Self-Governance And Socialism In Puerto Rico, 1934-52, Carmen Lopez Villamil

Kaplan Senior Essay Prize for Use of Library Special Collections

In 1946, three Boston judges decided that the Puerto Rican legislature could redistribute American-owned sugar plantations to workers. Though deemed legal, the redistribution never happened. The unreported 1946 land rights case, People of Puerto Rico v. Eastern Sugar Associates, entangles how self-proclaimed socialist and anti-colonialist officials at the Department of the Interior administered a New Deal empire across Indigenous and island territories. In conjunction with the Department of the Interior’s published reports and Felix S. Cohen’s Papers at the Yale Beinecke Rare Book and Manuscript Library, case files from the Boston First Circuit Library reveal engagement between federal and military …

Confessions Of A Failed Revolutionary Subject: Toi Derricotte And The Black Notebooks In The Archive, Kavya Jain

Kaplan Senior Essay Prize for Use of Library Special Collections

In this essay, I use black feminist methodologies to theorize archival voice as opposed to silence, drawing from Toi Derricotte’s 1997 book The Black Notebooks: An Interior Journey and its drafts. I examine Derricotte’s published and unpublished writings on the psychological wounds of racism, internalized antiblackness, shame, and the racial and relational politics of being white-presenting to understand her vision of how we free ourselves from the toxic imaginaries of race. I focus on Derricotte’s use of confession and her commitment to wayward speech, or saying the unsayable, to challenge political ideology’s domination of language and harness the political possibility …

Contraceptive Counseling For Transgender & Gender Diverse Patients: Provider Knowledge & Experience, Kathryn Callahan

Yale Medicine Thesis Digital Library

Many transgender and gender diverse (TGD) individuals have contraceptive needs. Contraceptive counseling in this population is often nuanced due to the diverse experiences and healthcare goals of TGD individuals. Testosterone therapy is an important component of gender affirming care for some transgender and gender diverse (TGD) individuals. A common misconception among patients and providers is the role of testosterone in pregnancy prevention. Testosterone is not an effective form of contraception due to its inconsistent suppression of ovulation. Previous studies have shown that some patients who use testosterone for contraception do so based on guidance from their healthcare provider. Therefore, this …

Atrial Myocyte Ampk Deletion Alters Single Nuclear Profiles In Mice, Julia Nicole Eisen

Yale Medicine Thesis Digital Library

Atrial fibrillation (AF) is the most common arrhythmia worldwide with about 1 in 4 adults expected to develop the condition in their lifetime. AMP-activated kinase (AMPK) is a critical energy sensor and regulates tissue energy and substrate metabolism. Our lab has previously shown that atrial cardiomyocyte-specific cardiac AMPK deletion induces electrophysiologic changes, left atria structural remodeling and spontaneous AF. The mechanism by which loss of AMPK and consequent metabolic stress leads to AF has not yet been elucidated. Using single nuclear RNA sequencing (snRNA sequencing) of mouse heart atria from mice with atrial cardiomyocyte AMPK deletion, we begin to investigate …

Mass Sars-Cov-2 In A State Correctional System During The Pandemic, Charlotte Kim

Yale Medicine Thesis Digital Library

Mass screening has been shown to be more efficient in identifying infections in correctional facilities compared to symptom-based screening, but little is known about the impact of systematic mass screening on timely isolation of infectious cases over the course of the entire pandemic. Between March 2020 and May 2023, the Connecticut Department of Correction (CT DOC) performed a multifaceted SARS-CoV-2 testing strategy for its incarcerated population, which included RT-PCR for mass screening, as well as rapid antigen testing for contact tracing, symptom-based screening, and other miscellaneous reasons. Testing data reveals that mass screening identified 48% of all positive results, whereas …

Pancreatic Cancer Risk After Chronic Hepatitis C Virus Infection: A National, Population-Based Study, Rachel Levinson

Yale Medicine Thesis Digital Library

Studies of the association of hepatitis C virus (HCV), a known oncovirus, and pancreatic ductal adenocarcinoma (PDAC) are limited. We aimed to assess the relationship between chronic HCV infection, HCV genotype, and PDAC. In this retrospective cohort study, we identified individuals in the Veterans Health Administration from 2001 to 2021 with HCV testing. We categorized HCV status as those without HCV, those exposed (without chronic infection), or those with chronic infection. We evaluated incident PDAC by HCV status using Cox proportional hazards regression, adjusting for pertinent confounders. We further investigated the association between HCV genotype and risk of PDAC. Of …

Pregnancy Outcomes After Glp-1 Receptor Agonist Exposure And Ethical Considerations, Nishita Pondugula

Yale Medicine Thesis Digital Library

The objective of this study is 1) to understand the effect of GLP-1 receptor agonist (GLP-1RA) use in the year prior to conception on risk of developing hypertensive disorders of pregnancy (HDP) and on gestational weight gain (GWG), and 2) to analyze important ethical considerations relevant to research in pregnancy and specifically related to GLP-1RAs.All patients delivering between 2014-2024 with evidence of GLP-1RA exposure in the year prior to conception were identified through electronic medical record (EMR) query with hand review to confirm exposure. GLP-1RA exposed patients were classified according to GLP-1RA indication for use: 1) pregestational diabetes mellitus (PGDM) …

Macrophage Migration Inhibitory Factor And D-Dopachrome Tautomerase As Biomarkers And Key Modulators Of Tumor Progression In Head And Neck Cancer And Melanoma, Caroline Naomi Valdez

Yale Medicine Thesis Digital Library

Macrophage Migration Inhibitory Factor (MIF) and its homolog D-dopachrome Tautomerase (DDT) are pro-inflammatory cytokines implicated in tumor progression across multiple cancers. Both MIF and DDT act through canonical CD74 and non-canonical CXCR2/4/7 signaling pathways, which contribute to immune suppression and tumor progression. Elevated MIF levels are associated with metastasis and poor prognosis in HNC and contribute to immune checkpoint inhibitor (ICI) resistance in melanoma. DDT’s role in cancer is not well understood. This study aims to evaluate the expression and therapeutic potential of MIF and DDT inhibition, focusing on their ability to modulate immune responses and improve survival outcomes as …

Bipolar Disorder Among Individuals With Atopic Dermatitis: A Case-Control Study In The All Of Us Research Program, Mitchel Wride

Yale Medicine Thesis Digital Library

Background: Atopic dermatitis has been associated with psychiatric comorbidities.Objectives: To characterize the association between atopic dermatitis and bipolar disorder with a case-control study of the NIH All of Us Research Program. Methods: Utilizing Systemized Nomenclature of Medicine diagnostic codes, we identified cases of atopic dermatitis. Four age, sex, and race/ethnicity matched controls were found for each case using propensity score matching. After controlling for age, sex, race/ethnicity, income, smoking status, and depression, the relationship between atopic dermatitis and bipolar disorder was evaluated using logistic regression. Results: We identified 13,431 atopic dermatitis cases with 53,724 matched controls. Participants with atopic dermatitis …

Provider Perspectives On Gestational Diabetes In Samoa: A Qualitative Study Of Barriers, Facilitators, And Opportunities, Andriana Nicole Marijic Buljubasic

Public Health Theses

Background: Gestational diabetes mellitus (GDM) is associated with significant maternal and neonatal risks, with Samoa facing a disproportionate burden of GDM linked to high obesity (76.7% of women), type 2 diabetes (19.5%), and cultural-systemic barriers to care[1]. Despite GDM accounting for 38% of pregnancy complications at Tupua Tamasese Meaole (TTM) Hospital, qualitative insights into GDM care or provider experiences remain limited. This study applies a socio-ecological framework to explore multi-level influences on GDM care within Samoa’s unique cultural context and healthcare landscape.

Aim: To understand the barriers and facilitators to effective care-team response when treating gestational diabetes patients at TTM …

Epidemiological Changes In Shiga Toxin-Producing Escherichia Coli (Stec) Pre- And Post-Covid In Connecticut, 2018–2019 And 2023–2024, Brooke Thanh-Hang Tran

Public Health Theses

Background: Shiga toxin-producing Escherichia coli (STEC) causes over 265,000 infections, 3,600 hospitalizations, and 30 deaths annually in the U.S.. While STEC O157 is the most common serotype, the increased use of culture-independent diagnostic tests (CIDT) led to a rise in non-O157 serotypes detected. Nationally, STEC incidence declined during the COVID-19 pandemic but has since surpassed pre-pandemic levels. An analysis was conducted to determine the changes that occurred in STEC infections in Connecticut from pre-pandemic to post-pandemic and to identify differences between culture-confirmed cases and CIDT-only/untyped cases.Methods: A descriptive analysis using STEC surveillance data collected in Connecticut was performed to identify …

Bringing Culinary Medicine Teaching Principles To Children In The New Haven Community: An Interventional Pilot Study, Rachel Lutz

Yale Medicine Thesis Digital Library

Culinary medicine is a growing field dedicated to combining culinary skills and evidenced-based practices to promote health. While it has proven to be efficacious in improving biometrics for chronic diseases in adults, potential remains for its application in pediatric populations. This pilot study creates and evaluates a one-time community-based culinary medicine intervention for a mixed-age pediatric group. The intervention included a didactic lecture and five interactive stations for 20 research participants and 22 non-research participants at a community site. The intervention was evaluated for knowledge, attitudinal, and behavioral impact using pre-post surveys. Given the importance of food access in the …

Chimerism Testing In Myeloid Malignancies: Practical Guidance And Clinical Correlates, Christian Puzo

Yale Medicine Thesis Digital Library

Relapse is the primary cause of mortality for patients with myeloid malignancies post-allogeneic stem cell transplant (aSCT). As early intervention for those deemed high risk for relapse may improve outcomes, identification of residual malignant cell burden is of critical importance. Chimerism testing, the use of DNA sequencing technology to determine the relative percentage of donor to recipient hematopoietic cells post-aSCT, offers a practical metric to monitor for residual leukemic cell burden. The precise value of donor chimerism is influenced by many procedural and contextual factors, and multiple strategies, including the analysis of specific hematopoietic cell subsets, termed lineage-specific chimerism (LSC), …

Development And Application Of New Method And Platform For Correlated Oxides, Zheting Jin

Yale Graduate School of Arts and Sciences Dissertations

Strongly correlated oxides, including high-temperature superconductors such as cuprates and nickelates, exhibit complex quantum phenomena that can challenge conventional electronic structure theories. This thesis develops and applies advanced computational methods to study these systems, aiming to provide a comprehensive first-principles description of their structural, spin, and electronic properties. First, a novel cluster slave-particle method is introduced to improve the treatment of electron correlations in extended Hubbard models, capturing strong correlation effects with high computational efficiency and benchmarking well against established many-body techniques. This method is then combined with density functional theory calculations and applied to cuprates, where we demonstrate how …

The Influences Of Redox-Active Ligands On Nitrogen Reduction Catalysts, Alexander S. Hegg

Yale Graduate School of Arts and Sciences Dissertations

This thesis describes the synthesis, characterization, and reactivity towards N2 reduction of a number of group 6 and 7 transition metal complexes bearing redox-active ligands. Chapter 1 introduces the field of nitrogen fixation, the role of transition metal catalysts in mediating nitrogen reduction, and some of the challenges that potential catalysts must overcome. Chapter 2 describes a number of molybdenum porphyrin complexes that were viable catalysts for N2 reduction with samarium diiodide and alcohol. The reduction of the ligand facilitates chemical transformations at the metal with strong acids and leads to NH3 formation. Chapter 3 describes the effects of exchanging …

The Shaping Of Religion Through Empire In Modern Korea, 1876-1948, John Grisafi

Yale Graduate School of Arts and Sciences Dissertations

This dissertation covers the roles of multiple empires in the discursive formation of religion in modern Korea, with emphasis on the period from 1876 through 1948. I argue that although semi-analogous terms and ideas to “religion” existed in Korea prior, the coinage of the modern Korena term for religion, chonggyo (종교, 宗敎) in 1883 and its subsequent discursive development were heavily shaped by imperialism, colonialism, and modern globalization. The pressures and influences of empires triggered a coalescence of Korean concepts of religion and related ideas. But the involvement of multiple empires as well as Korean interests, and the beliefs and …

Epidermal Stem Cells Control Periderm Mechanics And Injury Repair Via Matrix-Driven Specialization Of Intercellular Junctions, Mengze He

Yale Graduate School of Arts and Sciences Dissertations

Epidermal stem cells interact with the extracellular matrix (ECM) to regulate their differentiation and maintain skin architecture. Yet, it remains unclear whether these interactions extend beyond cell fate determination to influence broader skin functions. Here, we demonstrate that the protective, mechanically shielding properties of the periderm -the superficial epidermal cells (SECs) of the embryonic bilayered skin - are orchestrated by interactions between the underlying undifferentiated basal epidermal stem cells (BECs) and the ECM. Using the developing zebrafish fin fold, we identify that BECs form distinct collagen- versus laminin- enriched basement membranes, enabling the SECs above the BEC-laminin areas to close …

Structural Studies Of Cellular Prion Protein And Amyloid-B Oligomers, Lauren Klein

Yale Graduate School of Arts and Sciences Dissertations

Alzheimer's Disease (AD) is a neurodegenerative disease with significant societal impacts. AD is the only top ten leading cause of death that cannot be prevented, cured, slowed, or even diagnosed before symptoms are present. AD, similar to other neurodegenerative diseases, has been linked to protein aggregation as the key factor in the disease pathology. However, the mechanism by which AD proliferates is poorly understood. Recent advancements in techniques and methods in structural biology, including nuclear magnetic resonance (NMR) and electron microscopy (EM), have opened a new era of studies into protein aggregates implicated in neurodegenerative diseases, including AD. Therefore, this …

Representation Theory, Geometry And Combinatorics Associated To Springer Fibers, Do Kien Hoang

Yale Graduate School of Arts and Sciences Dissertations

This dissertation explores various aspects of Springer fibers and their deep connections to geometric and combinatorial representation theory. It combines the works of [H24a], [H24b], and [H24c] by the author during his PhD. Throughout these works, we explain sophisticated roles of Springer fibers in modern topics like modular representation theory and symplectic duality. Additionally, we resolve several classical questions concerning the Springer correspondence and the cohomology of Springer fibers.

The first project centers around a discretization of a Springer fiber Be. This discretization is a finite set Ye that has appeared in various contexts in representation theory. …

Studies Towards Improving Ni-Catalyzed Cross-Electrophile Coupling Reactions, Haotian Huang

Yale Graduate School of Arts and Sciences Dissertations

This thesis summarizes work towards improving Ni-catalyzed cross-electrophile coupling reactions through the development of new homogeneous organic electron donors and the understanding of ligand effects on key proposed elementary steps. Chapter 1 provides an overview of the current use of homogeneous organic electron donors and mechanistic understanding in Ni-catalyzed cross-electrophile coupling reactions. Chapter 2 describes the development of two new types of homogeneous reductants and their catalytic relevance. Chapter 3 details the effects of 6,6′-substituents on bipyridine-ligated Ni catalysts for cross-electrophile coupling. Chapter 4 describes progress towards understanding ligand effects on alkyl radical capture at NiII complexes, a key elementary …

Evaluating Ancient Volcanic Disaster In The Río Grande De Chone, Manabí, Ecuador, Corey Alexander Herrmann

Yale Graduate School of Arts and Sciences Dissertations

Across the world, disasters are increasing in their frequency and in their intensity. This is due to a confluence of factors social (like modern development and population growth) and “natural” (such as the inputs of anthropogenic climate change). Social scientists in anthropology are pursuing the field of disaster anthropology to explore these shifting trends and investigate the human response to disasters today. Archaeologists, in turn, have focused instead on exploring disaster more concretely through identifying exposure to particular hazards, leaving deeper questions of the social character behind disaster processes relatively undertheorized.

Archaeologists working in South America have been quite attuned …

Gene Expression Regulation By Pabpn1 Phosphorylation And Microexon Splicing, Jackson Miles Gordon

Yale Graduate School of Arts and Sciences Dissertations

The processing of pre-mRNAs into mature mRNAs is a key regulatory step in eukaryotic gene expression programs. Before an mRNA can be exported to the cytoplasm, its 5′ end must be modified with a 7-methylguanosine cap structure, intervening non-coding sequence must be removed (spliced), and a poly(A) tail must be synthesized at its 3′ end. Each of these processes are dynamic and provide contextual regulation, tuning an mRNAs coding capacity, stability, and translation potential as needed. The Neugebauer Lab has developed highly specialized tools to dissect how RNAs are spliced, cleaved, and polyadenylated in numerous biological systems. In this study, …

From Success To Setbacks: A Case Study Of The Sex Wrap And The Impact Of Instagram's Evolving Policies On Sexual Health Education, Megan Piller

Public Health Theses

Due to the inconsistent and noncomprehensive nature of sexual health education across the United States, many adolescents and emerging adults are turning to digital platforms, specifically social media, for necessary information. The Sex Wrap (TSW), a podcast and Instagram-focused intervention, was established to fill critical knowledge gaps among these populations and empower them in their sexual decision-making. To serve as a case study, engagement metrics from TSW’s Instagram account between October 2020 and September 2021 were analyzed to determine which post types, tones, and thematic categories resonated most with users across the platform. However, Instagram, once a highly effective tool …

Long Covid And Vulnerability To Climate Change’S Health Effects: An Informational Booklet For Healthcare Settings, Rachel Nussbaum

Public Health Theses

According to the World Health Organization, around 10–20% of people infected by COVID-19 may go on to develop symptoms that can be diagnosed as Long COVID, also known as the post-acute sequelae of COVID-19 (PASC). While the risk of Long Covid among people who received the primary vaccine series fell to 3.5% in one study, as of September 2024, over 1.3 million Americans were being infected with SARS-CoV-2 every day, and reinfections increase the likelihood of experiencing Long Covid in some studies. Continued transmission of SARS-CoV-2 has led to roughly 400 million people experiencing infection-associated chronic conditions, creating an accumulating …

Effect Of Wildfire Smoke Pm2.5 On Preterm Birth Outcomes: A Generalized Synthetic Control Analysis Of Preterm Births In The Contiguous United States From 2006 To 2020, Alexandra Maria Nechaev

Public Health Theses

Wildfire activity has intensified across the United States due to climate change, contributing to rising levels of smoke-attributable fine particulate matter (PM2.5) in ambient air. Wildfire-specific PM2.5 is linked to adverse health outcomes, including increased risk of preterm birth, a leading cause of infant morbidity and mortality. Despite growing concern, few studies have applied quasi-experimental methods to evaluate the causal effects of wildfire-attributable PM2.5 on preterm birth across large, diverse populations and geographical areas. This study estimated the effect of wildfire-specific PM2.5 exposure on preterm birth rates across all counties in the contiguous United States from 2006 to 2020 using …